drowning death
TRANSCRIPT
DROWNING CASES…….
Presented by… RAKESH KUMAR MISHRA , ,(M.Sc.1st
year SHIATS,ALLAHABAD)
Contents….• Introduction• Classification• Vicious cycle of drowning• Medico legal aspects….• Postmortem findings…..• Biochemical changes….• Diatoms ….• Cause of death….• Diagnosis of drowning
Drowning: Is a form of asphyxia due to
aspiration of fluid into the air passage, due to submersion in fluid or water.
Complete submersion is not necessary, that of mouth and nose alone for a sufficient period can cause death from drowning.
Introduction…..
Classification …• Typical • Atypical Typical drowningObstruction of air passages and lungs by inhalation of fluid and is known as “Wet drowning”.Typical signs are found at autopsy.
Atypical drowning….Conditions in which there is very little or no inhalation of water or fluid in the air passages. Dry drowning. Immersion syndrome(vagal
inhibition). Submersion of the unconscious. Secondary drowning
syndrome/near-drowning.
Typical drowning…. Fresh water drowning. Salt water drowning.
Fresh water drowning Water cross the alveolar membrane
into the circulation. Produces marked hypervolemia. Red cells swell or burst-hemolysis-
liberation of potassium. Circulation will suffer 50% dilution
within 2-3 min.
The heart is submitted to the insult of anoxia,hypervolaemia,potassium excess and sodium deficit.
Ventricular fibrillation due to anoxia and potassium excess within 4-5 min.
Salt water drowning Marked hypertonicity of the
inhaled water cause loss of fluid from circulation into the lungs-fulminating pulmonary edema and progressive hypovolemia.
Circulatory shock and cardiac arrest.
Atypical drowning Dry drowning Intense laryngeal spasm due to
entry of water into nasopharynx and larynx.
Very little water enters into lungs. Best case for resuscitation. Immersion syndrome Due to sudden impact with very
cold water and causes death from cardiac arrest.
Victims are young people with excess of alcohol.
It also result from falling or diving with feet or duck diving by the inexperienced swimmers.
Loss of consciousness instantaneous and death occurs in few minutes.
Autopsy disclose non of the usual signs of drowning.
Submersion of the unconscious Commonly seen if the victim is
suffering from disease like epilepsy,heart diseases and is drunk or head injury during fall.
Ballooning of the lungs may be absent.Formation of the foam my be negligible.Complete picture of death by drowning
is not found.Secondary drowning/near-drowningIts mainly due to infection from
inhalation of contaminated water. Lung complications, oxygen lack, tired
heart muscle and cerebral edema. A victim look alert and breathing, may
respond to initial resuscitation. Late stage-respiratory distress,
hypotension and cardiac arrhythmia may cause death.
Deep inspiratio
n Water enters
resp.passage
Cough reflex
Air driven out of lungs
Need for air
Vicious cycle of drowning
Medico legal aspects…. Whether the death was due to
drowning or other cause? Length of time the body was in
water.Whether it was accidental/suicidal/homicide?
Postmortem findings….. External findings Fine froth at the nose and mouth.
Its whit or rarely blood stained, leather- like, abundant and increases in amount with compression of the chest.
Rarely the presence of weeds, mud etc. in the tightly clinched hand.
Cutis anserine(Goose skin)… Due to spasm of the erector pilae muscles
and due to exposure to cold water at the time of death.
Rarely seen in India. Skin appears granular and puckered, with
hair standing on the end. Extremities are mainly affected. The skin of the finger, palms and later the
soles of the feet may be wrinkled, bleached and sodden.
Due to osmotic action of water, on thickened epidermis.
This immersion changes known as Hands and Feet of a Washer-Woman.
Internal findings….Lungs & respiratory tract:- Airways filled with froth,sand,weeds etc found in
the water.Lungs are voluminous,edematous,doughy to feel with rib markings. Paltauf’ hemorrhages seen. C/s:- Oozing out of blood stained frothy fluid and
ballooning of the lungs is known as “Emphysema Aquosum”.
Wt upto 2 kgs. Watery fluid transudates into pleural cavities during
putrefaction. Hydrostatic lung:- 2meters depth-20min. Hemorrhages in the middle ear & mastoid air cells. Water in the stomach & intestine.
Biochemical changes….“Getlers test” Chloride content in chambers of the
heart normally 600mg/100ml. Chloride decreases by 50% in fresh
water & increases of 40% in salt water.
Test is of doubtful value in -Septal defects -Putrefaction -Death due to vagal inhibition -Chloride in water
Diatoms …. Microscopic unicellular algae present
in water. Silicaceous cell wall which resists acid
digestion, heat and putrefaction. Size 10-80 microns. Only a live body with a circulation can
transport diatoms from lungs to the brain or bone marrow.
Isolation- acid digestion of tissue commonly bone marrow,lung,blood and kidney-centrifugation and washing. Residue is examined under phase contrast microscopy.
Cause of death…. Asphyxia Ventricular fibrillation Laryngeal spasm. Vagal inhibition. Exhaustion. Injuries. Fatal period 4-8min.
Diagnosis of drowning…. Froth Weeds & gravel/soil in
hand. Voluminous lungs. Diatoms in tissues.